Relationship of the Celiac Trunk with Median Arcuate Ligament of … · 2009. 8. 3. · was...

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INTRODUCTION

The syndrome of celiac trunk compression (or celiacaxis compression syndrome) is a nosologic entity that hasbeen recently introduced in the abdominal vascular pathologyfield based on the clinical-radiological observations bycorrelating abdominal symptoms caused by the compressionof celiac trunk crura (Dunbar et al., 1965). Since then, severalcases have been reported describing this syndrome (Debray& Leymarios, 1968; Fadhli, 1968; Harjola, 1968; Edwards,1969; Hivet & Lagadec, 1970; Stanley & Fry, 1971; Ciscatoet al., 1976; Joubaud et al., 1977; Kokotsakis et al., 2000;Roayaie et al., 2000; Dordoni et al., 2002; Alehan & Dogan,2004 and Desmond & Roberts, 2004).

This syndrome is characterized by the triad abdomi-nal pain, systolic bruit and stenosis of the celiac trunk(Thevenet et al., 1985).

Several studies established a correlation betweensyndrome suppression and decompression of the celiac trunkdue to surgically sectioning of the median arcuate ligament(Bessot et al., 1970) or with a sympathectomy anddenervation of the celiac ganglion sectioning the nervousfibers (Snyder et al., 1967), or associating both surgicalprocedures (Carey et al., 1969; Cormier & De La Fontaine,1970 and Hivet & Lagadec).

Int. J. Morphol.,24(2):263-274, 2006.

Relationship of the Celiac Trunk with Median ArcuateLigament of the Diaphragm

Relación del Tronco Celíaco con el Ligamento Arqueado Mediano del Diafragma

*Selma Petrella; **Celio Fernando de Sousa Rodriguez; ***Emerson Alexandre Sgrott; ****Geraldo José Medeiros Fernandes;****Sergio Ricardo Marques & ****José Carlos Prates

PETRELLA, S.; RODRIGUES, C. F. S.; SGROTT, E. A; FERNANDEZ, G. J. M.; MARQUES, S. R. & PRATES, J. C. Relationshipof the celiac trunk with median arcuate ligament of the diaphragm. Int. J. Morphol., 24(2):263-274, 2006.

SUMMARY: In the present study different positions of the median arcuate ligament in relation to the celiac trunk as well asmeasurements of overlap and distance, also the approach between the two structures were investigated. In addition histological studies ofthe diaphragm crura and the median arcuate ligament were performed.

Sixty-three cadavers fixed in formalin 10% aqueous solution and 20 non-fixed adult cadavers of both sexes were studied. Dissectionsof the celiac trunk were performed after dissection of the peritoneal cavity in the laboratories of the Anatomy Division of the UNIFESP-EPM, UNILUS and UNISA, and during necropsies in the City Morgue of the UNIFESP-EPM and USP.

Regarding morphological analysis under light microscopy, three non-fixed cadavers were randomly chose and fragments measuring5 cm height versus 2,5cm length of the median arcuate ligament were removed and processed according to routine techniques of inclusion.Sections of 5 µ m were hematoxyline-eosin stained according to Masson’s technique.

The results allowed us to conclude the following: 1) the positions of the median arcuate ligament in the celiac trunk wereanalyzed irrespective of the gender. In 12 (14.46%) out of the 83 cadavers, the celiac trunk was distant from the median arcuate ligament.In 35 (42.17%) cadavers this ligament touched the celiac trunk and in 36 (43.37%) overlaps this vessel. The mean distance between themedian arcuate ligament and the celiac trunk was 0.94 cm and the overlap was 0.42cm; 2) the histological analysis of the median arcuateligament showed a dense connective tissue infiltrated by adipose cells, blood vessels and nerves. Striated skeletal muscle fibers intermingledwith collagenous fibers was observed in continuity to the tissues above mentioned.

KEY WORDS: Celiac trunk; Ligaments; Syndrome; Diaphragm; Arterial occlusive disease.

* Arbovirus Division, Adolfo Lutz Institute, São Paulo, Brazil.* * Department of Morphology, Federal University of Alagoas, Brazil.* * * Descriptive and Topographic Anatomy Division, Vale do Itajaí University, Santa Catarina, Brazil.* * * * Descriptive and Topographic Anatomy Division, Federal University of São Paulo, Brazil.

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Some studies have reported the occurrence ofcompression associated with origins of the celiac trunk as wellas with the superior mesenteric artery by means of the me-dian arcuate ligament of the diaphragm (Gautier-Benóit etal., 1970; Lord et al., 1968; Edwards; Broussin et al., 1970;Curl et al., 1971; Mulder et al., 1971; Stanley & Fry; Watt,1972; Daily & Fogarty, 1976; Watson & Sadikali, 1977;Houssin et al., 1979; Langeron et al., 1980; Ghosn et al., 1982;Rogers et al., 1982; Bacourt et al., 1984; Lawson & Ochsner;Thevenet et al.; Bacourt et al., 1988 and Loffeld et al., 1995).

The physiopathological mechanisms of the pain in thecompression of celiac trunk syndrome are not very clear andtwo theories have been proposed: the ischemic and the neurogenictheories (Thevenet et al.). It had been long asked if the syndromereally exists causing abdominal pain (Szilagyi et al., 1972;Evans, 1974; Brandt & Boley, 1978; Croft et al., 1981 and Plateet al., 1981) although the beneficial effects of the surgicalincision of the median arcuate ligament indicate a correlationbetween abdominal pain and the stenosis angiographicallyobserved (Edhag et al., 1977 and Lawson & Ochsner).

Although the real frequency of this syndrome is stillunknown and many cases are randomly discovered (Huguetet al., 1972) its occurrence is frequent (Warter et al., 1969;Warter et al., 1970a and Colapinto et al., 1972). It isconsidered a real pathological entity whose surgical treatmentis susceptible to ensure healing at long term in approximately80% to 86% of the cases (Olivier et al., 1970; Warter et al.,1976 and Tridico et al., 1988).

Our purpose was to conduct a systematic research onthis subject based on the observations presented by theauthors, mainly in the last decades, almost always clinicallyor surgically regarding the celiac trunk. We aimed todemonstrate its behavior in relation to diaphragm crura andin particular with the median arcuate ligament or intercrural,trying to provide anatomical data on this syntrophy. Sincethere are controversies regarding the architecture of themedian arcuate ligament, observations based on its structurewill be presented under light microscopy.

MATERIAL AND METHOD

Eighty three cadavers from the following institutionswere dissected: Death Verification Service of the FederalUniversity of São Paulo (UNIFESP/EPM), Obituary Serviceof the city of São Paulo at the Medical University of SãoPaulo (USP) and Anatomy Laboratories at the FederalUniversity of São Paulo (UNIFESP/EPM), Medical SciencesFaculty of the Lusíada University Center (UNILUS) and theSanto Amaro University (UNISA), Brasil.

Sixty three cadavers fixed in 10% formalin solutionwere dissected, with ages ranging from 21 to 82 years, ofwhich 54 were males and nine females and 20 non -fixedcadavers were maintained in a frigorific chamber were alsodissected, of which 12 males and eight females, with agesranging from 34 to 88 years. Dissection processes wereperformed during necropsies at the Death Verification Serviceof the city of São Paulo, in the Medical University of SãoPaulo and in the Death Verification Service of the FederalUniversity of São Paulo, Brazil.

To dissect the celiac trunk and the superior mesentericartery in the fixed cadavers, the pancreas was removed or hadits body sectioned or divided with the aid of a scissor. In non-fixed cadavers, the celiac trunk and the superior mesentericartery were reached by the omentum, opening the flaccid partof the lesser omentum. Ganglions and the nervous tissue ofthe celiac plexus, involving the initial segment of thementioned vessels (celiac trunk and superior mesentericartery), were withdrawn with the aid of a pincer and scissorto allow observing disposition of these arteries from the origin.

After resection of connective tissue adjacent to thediaphragm crura and also resection of the adhered tissues tothe median arcuate ligament contour, these structures wereexposed allowing observation of their relationships with theceliac trunk.

Mensuration of the distance between the celiac trunkand the median arcuate ligament.

This distance was assessed in 12 out of the 83cadavers between the superior margin of the origin of theceliac trunk and the free edge of the median arcuate ligament.

Mensuration of overlap of the median arcuateligament in the celiac trunk.

The distance of the overlap of median arcuateligament was assessed in 36 out of 83 cadavers and wasobtained in the first centimeters close to the origin of theceliac trunk.

Histological studies. Fragments of the median arcuateligament measuring 0.5 cm of height by 1.5 cm of width ofthree non- fixed cadavers who were maintained in frigorificchamber were resected and embedded in Bouin’s solutionand processed according to the methodology established byMasson. The fragments were paraffin embedded and thesections measuring 5 µ m in thickness were performed. Thesewere submitted to staining methods hematoxylin and eosinand Masson´s trichrome method for histological analysisunder light microscopy.

PETRELLA, S.; RODRIGUES, C. F. S.; SGROTT, E. A; FERNANDEZ, G. J. M.; MARQUES, S. R. & PRATES, J. C.

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Statistical Analysis (Siegel et al., 1976). To study the possibleassociations between sexes and the situation of the medianarcuate ligament in the celiac trunk, in a type 2 x 2table, theChi-square test for two independent samples was used.

The rejection level for the null hypothesis was fixedin a value smaller or equal to 0.05% (5%).

When the calculated statistics did not presentsignificance, NS was used to characterize it.

RESULTS

Situation of the median arcuate ligament in relationto the celiac trunk. The results are shown in Table I.

celiac trunk and the left crus maintaining contact with thelateral portion of it or surrounding it in some millimeters. Inthree other cases, it was seen that the right crus wassurrounding the celiac trunk and the left one was distant fromit; and, in three cases, the opposite occurred: the left cruswas surrounding the celiac trunk and the right was maintaineddistant from it.

Also, the median arcuate ligament overlapped theceliac trunk in 36 cadavers (43.37%) (Figs. 3 and 4).

The mean extension of the median arcuate ligamentoverlapping the celiac trunk was 0.42cm, maximum 1.0cmand minimum 0.1cm. An overlap of 0.10cm was observedin four (11.11%), 0.15cm in one (2.78%), 0.20cm in11(30.56%), 0.30 cm in one (2.78%), 0.40 cm in two (5.56%),0.50 cm in five (13.89%), 0.52 cm in one (2.78%), 0.55 cmin one (2.78%), 0.60 cm in three (8.33%), 0.63 cm in one

Fig. 1. Male. Adult. Celiac Trunk (ca); Left gastric artery (lga);Splenic artery (sa); Common hepatic artery (cha); Right crus (rc);Left crus (lc). Observe the median arcuate ligament 0.2cm distantfrom the celiac trunk.

Table I. Situation of the median arcuate ligament in the celiac axisin cadavers according to gender and result of statistics.

X2 calc. = 0,457 NS

The different positions of the median arcuate ligamentwere analyzed irrespective of the patient’s gender. In 12cadavers (14.46%) the median arcuate ligament was distantfrom the celiac trunk (Fig.1).

The mean distance between the median arcuateligament and the celiac trunk was 0.94 cm, with a minimumdistance of 0.2 cm and maximum of 2.32cm. A distance of0.20 cm was observed in two cadavers (16.67%), 0.30 cm inone cadaver (8.33%), 0.38 cm in one (8.33%), 0.50 cm inthree (25%), 0.7cm in one (8.33%), 1.8 cm in one (8.33%),1.9 cm in one (8.33%), 2.0 cm in one (8.33%), 2.32 cm inone (8.33%).

The percentage of cadavers with the median arcuateligament touching the celiac trunk was 42.17% (35 cadavers)(Fig. 2).

It was observed that 29 out of 35 cadavers with themedian arcuate ligament touching the celiac trunk had theright crus surrounding almost all the superior margin of the

Relationship of the celiac trunk with median arcuate ligament of the diaphragm. Int. J. Morphol., 24(2):263-274, 2006.

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Fig. 2. Adult male. Celiac trunk (ca); splenic artery (sa); commonhepatic artery (cha); left gastric artery (head of arrow); superiormesenteric artery (sma). Observe the median arcuate ligamenttouching the celiac trunk (arrows).

Fig. 3. Adult male. The median arcuate ligament (big arrows) wasmoved aside showing the celiac trunk (ca) with a “notch” (head ofarrow) due to the median arcuate ligament. Left gastric artery (smallarrow); splenic artery (sa); common hepatic artery (cha); superiormesenteric artery (sma).

Fig. 4. Adult male. Left gastric artery (lga); splenic artery (sa);common hepatic artery (cha). Median arcuate ligament (arrows).

Fig. 5. Adult male. Celiac trunk (ca) formed by splenic artery (sa)and common hepatic artery (cha). It is observed the initial segment ofthe left gastric artery (lga) under the median arcuate ligament (arrow).

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Fig. 6. Adult male. Photomicrography showing the median arcuate ligament of the diaphragm. It is observed the connectivetissue rich in collagenous fibers (CF) and striated skeletal muscular fibers (MF). Masson’s trichrome. 380 x.

Fig. 7. Male. Adult. Photomicrography showing the median arcuate ligament of the diaphragm. Observe the connective tissuerich in adipose cells (big arrow), blood vessels (small arrow) and nerves (head of the arrow). Masson’s trichrome. 380 x.


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(2.78%), 0.70 cm in one (2.78%), 0.75 cm in two (5.56%),0.90 cm in one (2.78%), 1.0 cm in two (5.56%). The mostfrequent overlap extension was 0.2 cm. Only in two (2.25%)cadavers overlap of the ligament was observed in the initialsegment of the left gastric artery with an independent originin aorta (Fig. 5).

Regarding the overlap relationship between the rightor left crus of diaphragm on the celiac trunk, 36 cadaverspresented overlap of this trunk by the left crus in five cases,with extension of 0.2 to 0.9 cm, mean of 0.59 cm. In eight ca-ses, it was observed the right crus overlapping from 0.1 to 0.7cm,mean of 0.3 cm. In the other 23 cadavers, both crura werecovering the celiac trunk from 0.1 to 1cm, mean of 0.4 cm.

Histological description of the median arcuateligament of the diaphragm. Based on the histologicalanalysis of the median arcuate ligament of the diaphragm, itwas observed that it is consist of its lower region, that is, theinferior edge of the aortic hiatus towards the upper region of

the muscular fibers of the diaphragm crura, by thick layer ofdense connective tissue rich in collagenous fibers andinfiltrated by adipose cells, blood vessels of different calipersand several nervous filaments. Superiorly, continuing thislayer, we found several muscular striated skeletal fibersintermingled by collagen fibers, emphasizing that thesemuscle fibers are covered by a rich connective tissue withcollagenous fibers (dense connective tissue), which may havedifferent thickness depending on the analyzed region (Figs.6 and 7).

DISCUSSION

In the literature studies on the syndrome are limitedto angiographies and surgery with lack of morphological data.Therefore, further specific researches, in dissected cadavers,on the celiac trunk behavior are needed in relation to thediaphragm crura and the median arcuate ligament.

Fig. 9. Adult male. Celiac trunk (ca); right crus (rc). Left crus (lc).Observe the median arcuate ligament as a fibromuscular arciformstructure (arrows).

Fig. 8. Adult male. The celiac trunk (ca) was sectioned. Medianarcuate ligament (arrows), right crus (rc), left crus (lc). The fascia(f) covering the crura and the median arcuate ligament was remo-ved. Observe the median arcuate ligament in a triangle shape andending as a fibrous ring (arrows).


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In the present study, by means of an anatomic study,we could observe the measures of positions that the medianarcuate ligament may have in relation to the celiac trunk andto compare them with those obtained in the analyzedliterature.

Angiographic studies during respiration processshowed the dislocation of the median arcuate ligament, aor-ta and celiac trunk, resulting in a greater approximationbetween the celiac trunk and the median arcuate ligament inthe expiration (Reuter, 1971; Stanley & Fry and Reuter &Bernstein, 1973). These studies led us to conclude that theposition of the median arcuate ligament in relation to theceliac trunk does not correspond to those found in fixedcadavers or not.

In our study, the minimum measures registered inmensurations were: 0.1cm for overlap of the median arcuateligament and 0.2cm for the distance between the medianarcuate ligament and the ostium of the celiac trunk.

Our results revealed that the inferior edge of the me-dian arcuate ligament remained distant from the celiac trunkin 14.46% out of the 83 cadavers (Fig. 1), differing from thefindings of Brunet et al. (1993) who referred 45% of 140cadavers and from George (1934) who observed 42.11% outof 38 cadavers. The mean distance between the celiac trunkand the median arcuate ligament was 0.94 cm, differing fromthe findings of Brunet et al., who observed a distance of 3.4mm, on average, and similar to those of Joubaud et al., whoreported a distance from10 to 20mm.

The touch of the celiac trunk by the median arcuateligament was observed in 42.17% of the cadavers, this resultdifferent from those found by Brunet et al. who noted in55% and those 36.84% observed by George (Fig. 2).

The term “touch” here used means the contactbetween the median arcuate ligament and the origin of theceliac trunk.

In our series we could observe that in most of thecases the celiac trunk was surrounded by the right crus andit is explained by its greater size in relation to the left crus.In 43.37% of the cadavers, we observed that the medianarcuate ligament was overlapping the celiac trunk, which isnot in accordance to 21.05% mentioned by George and those10% reported by Brunet et al. (Figs. 3 and 4).

Lindner & Kemprud (1971) showed among 72 non-fixed cadavers, 20 (26%) had the origin of the celiac trunktouching the free edge or below the median arcuate ligament,differing from the 71 (85.54%) cadavers found in this study

with the median arcuate ligament touching or overlappingthe celiac trunk.

Regarding relationship of diaphragm crura and theceliac trunk we found the left crus covering the celiac trunkin five cadavers, in an extension of 0.59 cm, on average, andthe right crus covering 0.30 cm, on average, in eight. Thisfact was identified by Tahery (1968); Balmes et al. (1971);Cornell (1971); Drèze et al. (1972) and Lawson & Ochsner.These authors did not present numerical data.

Additionally to angiographies, several non-invasivemethods, such as echo Doppler or pulsatile color flow Dopplerimaging (Tridico et al.; De Pauw et al., 1992 and Sproat et al.,1993), computerized tomography (Loffeld et al.), digitalsubtraction angiography (Desmond & Roberts), magneticresonance angiography and the color duplex ultrasonography(Alehan & Dogan), have been able to detect the celiac trunkcompression syndrome. We cannot compare our results withthese methods since they were not used in our study.

Several angiographic studies (Bobbio et al., 1967;Debray et al., 1967; Snyder et al.; Bobbio & Zanella, 1971;Conti et al., 1973; Furnemont, 1974; Joubaud et al.; McSherry, 1977; Langeron et al. and Mongelli et al., 1980)reported an overlap of the median arcuate ligament from 1to 2 cm which is not in accordance with the real measures.

Some authors admit that the higher origin of the celiactrunk in the aorta, the lower insertion of the median arcuateligament or both conditions may explain the anatomicanomaly of the celiac trunk in the compression syndrome(Hivet & Lagadec; Warter et al., 1970b; Lindner & Kemprudand Tridico et al.). According to Houdard et al. (1970) thefibromuscular hypertrophy is followed by an ectopy of theceliac trunk, which was originated some millimeters higherthan normal position.

Although it was not our objective to study skeloctopyof the celiac trunk and the median arcuate ligament, weobserved some variations in the position of the celiac trunk,sometimes in T12 and in others L1 or L2. Likewise, weobserved a free edge of the median arcuate ligament in amore superior position. We are in accordance with the resultsfound in the literature regarding the position of the celiactrunk between T12-L2 (Curl et al.; Stanley & Fry and Warteret al., 1976). On the other hand, our results are not inaccordance with those of Rubush et al. who found the celiactrunk in L3-L4.

Fadhli observed the celiac trunk 5 cm inside thethoracic cavity. In contrast to this finding, no similar casewas found in our sample.


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Some exceptional cases reported the simultaneouscompression of the celiac trunk and the superiormesenteric artery by the median arcuate ligament, whichcan be explained by the particular disposition of thesearteries in the aorta. Their origins are close and,sometimes, the initial segments of both are juxtaposed(Watson & Sadikali and Langeron et al.). The occurrenceof a simultaneous compression was not found in our study.

There are controversies on the concept of the ownstructure, limits and types of the median arcuate ligament.In our study, in five cadavers it was observed the medianarcuate ligament in a triangle shape interconnecting thetwo crura and with no skeleton muscular fibers on it andthe basis covering the celiac trunk, finishing like a fibrousring which formed the inferior margin of the diaphragmcrura (Figs.1, 8). These observations are in accordancewith those of Dunbar et al.; Bobbio et al.; Hivet &Lagadec; Leger et al. (1970); Furnemont and Brandt &Boley. In other cadavers, the median arcuate ligament waslike a fibromuscular structure covering the celiac trunk,ending like a fibrous arch presenting a variable width of1 to 2mm, (Fig. 9) or non identified, which is in accordancewith reports of many authors mentioning the medianarcuate ligament like a fibrous bridge, aciform andtransversally displayed forming the inferior margin of thehiatus aorticus of the diaphragm (Debray & Leymarios;Fadhli; Harjola; Harjola & Lahtiharju, 1968; Marable etal., 1968; Cormier & De La Fontaine; Edwards et al.,1970; Gautier-Benóit et al., 1970; Houdard et al.; Curl etal.; Di Marino et al., 1972; Drèze et al.; Conti et al.;Joubaud et al.; Houssin et al.; Langeron et al.; Daskalakis,1982; and Bacourt et al.). We are not in accordance withRuiz Liard et al. (1964) who mentioned the absence ofthis fibrous arch.

The median arcuate ligament also received thedenomination of median crus but due to behavior of thisstructure and comparing it with other formations in thelumbar part of the diaphragm, for instance, the medialand lateral arcuate ligaments, we judged that the bestdenomination would be the median arcuate ligament asmentioned in the Nonima Anatomica (1984).

In the histological analysis of the median arcuateligament, we could observed the presence of denseconnective tissue with collagenous fibers infiltrated byadipose cells, blood vessels and nerves. Continuing to thisstructure, some muscular skeletal fibers intermingled bythe dense connective tissue, blood vessels and adiposecells were detected. These findings are in accordance withthose of Harjola & Lahtiharju; Olivier et al.; Lindner &Kemprud; Drèze et al. andVan De Berg et al. (1972).

Likewise, we are in accordance with Bobbio et al.when they reported that in the reciprocal anatomicrelationship with the aortic hiatus we have the muscularfascia of the diaphragm, the aponeurotic formationcompleting it, the aorta and its branches, the celiac plexusshowing an intermingling of ganglions and fibers, weavinga network between the two crura and one adipose tissuefulfilling the empty areas.

Many authors referred to the aortic hiatus as thereal aortic channel (Ruiz Liard et al.; Bobbio, 1968 andDi Marino et al.). The denomination aortic channel isrelated to the complex formation, which converges uponthe aortic orifice of the diaphragm, which has an ellipticshape with its greater axe superoinferiorly andanteroposteriorly displayed, thus favoring itstransformation into a channel formed by arciform fibersof the median arcuate ligament (Bobbio et al., 1967).

We are in accordance with this denomination sincethe aorta crosses not only the hiatus, which is a limitedspace, but also a channel laterally formed by crura,posteriorly by the vertebra and anteriorly by the medianarcuate ligament with a variable extension.

Regarding the fact that the compression is due tothe median arcuate ligament and/or fibrosis of the celiactrunk or ganglion, in our opinion it is difficult to makeany reference only to the median arcuate ligament withoutthe plexus contribution. We agree with those authors whomentioned that during the surgical revascularizationprocess of the celiac trunk, compressed by the medianarcuate ligament, the section or exerese of the richfibronervous celiac plexus, whose fibers are deepintermingled with those of the median arcuate ligament,to access this ligament is almost a need (Harjola &Lahtiharju; Balmes et al. and Guibert et al., 1980).

The observation that the phreno-celiac diseasemight be associated to several morphological or metabolicabnormalities led some authors to conclude about theexistence of a new clinical entity, denominated as phreno-celiac congenital syndrome (Warter et al., 1970a; Warteret al., 1973a, 1973c; Warter et al., 1973b and Warter etal., 1974).

It is worth emphasizing the importance to conducta systematic research to detect the likelihood ofintercurrentdiaphragmatic stenosis in individuals withcongenital or hereditary anomalies or, if these conditionsoccurred we could consider the possibility of stenosis inthe celiac trunk, mainly when we are dealing with childrenwith some of these anomalies, considering that this


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phrenic-celiac syndrome was observed in some parentalcases (Dondival & Drèze, 1972; Drèze et al.; Van De Berget al.; Warter et al., 1974 and Bech et al., 1994).

Considering the median arcuate ligament in theceliac trunk compression syndrome, the results of the

present study are interesting since they contribute toenlighten morphology of this ligament. We believe thatfurther studies are needed aiming characterization ofsyntopy of diaphragm crura and celiac trunk with theconstitutional type, which may bring some light tounderstand this important nosological entity.

PETRELLA, S.; RODRIGUES, C. F. S.; SGROTT, E. A; FERNANDEZ, G. J. M.; MARQUES, S. R. & PRATES, J. C. Relacióndel tronco celíaco con el ligamento arqueado mediano del diafragma. Int. J. Morphol., 24(2):263-274, 2006.

RESUMEN: En el presente trabajo se investigaron las posiciones del ligamento arqueado mediano con relación al tronco celía-co, y las medidas de sobreposición y distancia entre estas dos estructuras. Además, fueron realizadas medidas de algunas variables comola longitud y el diámetro del tronco celíaco, estudios histológicos de los pilares del diafragma y de su ligamento arqueado mediano.

Utilizamos 63 cadáveres fijados en solución de formalina al 10% y 20 cadáveres no fijados, adultos, de ambos sexos. Lasdisecciones del área del tronco celíaco fueron realizadas después de disecar la cavidad peritoneal, en los laboratorios de la Disciplinas deAnatomía de la UNIFESP-EPM, UNILUS y UNISA, y durante las necropsias en los Servicios de Verificación de Óbitos de la UNIFESP-EPM y USP, Brasil.

Para el análisis morfológico, a nivel de microscopía de luz, de tres cadáveres no fijados escogidos al azar, fueron retiradosfragmentos del ligamento arqueado mediano de 0.5 cm de alto por 1.5cm de largo. Luego fueron procesados según técnicas tradicionalesde inclusión. Se efectuaron cortes de 5 µ m, los cuales fueron teñidos con hematoxilina-eosina y tricrómico de Masson.

Los resultados obtenidos permitieron llegar a las siguientes conclusiones: 1) Las posiciones del ligamento arqueado mediano enel tronco celíaco fueron independientes del sexo. En 12 (14.46%) de 83 cadáveres, se pudo observar al tronco celíaco distante delligamento arqueado. En 35 (42.17%) este ligamento era tangente al tronco celíaco y en 36 (43.37%) se sobreponía a este vaso. Elpromedio de la distancia entre el ligamento arqueado mediano y el tronco celíaco fue de 0.94 cm y la de sobreposición 0.42 cm; 2) losresultados histológicos del análisis del ligamento arqueado mediano mostraron al tejido conjuntivo denso, infiltrado por células adiposas,vasos sanguíneos y nervios. Fueron observadas fibras musculares estriadas, entremezcladas con fibras colágenas.

PALABRAS CLAVE: Tronco celíaco; Ligamentos; Síndrome; Diafragma; Enfermedad oclusiva arterial.

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Correspondence to:Prof. Dra. Selma PetrellaRua Rio Grande, 180 apto. 62São Paulo - Vila MarianaCEP 04018-000São Paulo - BRASIL.

Email:[email protected]


Received : 14-10-2005Accepted: 22-03-2006

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